Nyc Doe Request For Medical Accommodations - US Legal Forms 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name, OSIS number, and date of birth in the designated fields at the top of the form.
3. Indicate whether this request is for an IEP or 504 plan by checking the appropriate box. If applicable, provide the IEP classification.
4. In the medical intervention section, fill out the medical diagnosis along with any relevant ICD-10 or DSM-V codes. If allergies or other specific conditions apply, complete the addendum as necessary.
5. Specify if the condition is acute or chronic and indicate how long accommodations are expected to be needed.
6. Detail any required medical interventions, including medication administration needs and emergency medications. Attach any necessary Medication Administration Forms (MAFs).
7. Complete sections regarding supervision requirements and additional clinical concerns that may affect educational performance.
8. Finally, ensure that a healthcare provider signs and dates the form to attest to its accuracy before submission.

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